COPD quiz

The nurse reviews an arterial blood gas report for a client with chronic obstructive pulmonary disease (COPD). The results are as follows: pH 7.35; Pco₂ 62 (8.25 kPa); Po₂ 70 (9.31 kPa); HCO3 34 mEq/L (34 mmol/L). What should the nurse do first? Apply a 100% nonrebreather mask. Assess the vital signs. Reposition the client. Prepare for intubation.

Assess the vital signs. Clients with chronic COPD have CO2 retention, and the respiratory drive is stimulated when the PO₂ decreases. The heart rate, respiratory rate, and blood pressure should be evaluated to determine if the client is hemodynamically stable. Symptoms, such as dyspnea, should also be assessed. After assessing the vital signs, the nurse should assist the client as needed to assume the most comfortable position for breathing. Oxygen supplementation, if indicated, should be titrated upward in small increments. There is no indication that the client is experiencing respiratory distress requiring intubation.

When teaching a client with chronic obstructive pulmonary disease to conserve energy to conserve energy, what instruction should the nurse give the client about breathing when lifting heavy objects?Lift the object by: inhaling through an open mouth. exhaling through pursed lips. exhaling but before inhaling. taking a deep breath and holding it.

exhaling through pursed lips. Exhaling requires less energy than does inhaling. Therefore, lifting while exhaling saves energy and reduces perceived dyspnea. Pursing the lips prolongs exhalation and provides the client with more control over breathing. Lifting after exhaling but before inhaling is similar to lifting with the breath held. This should not be recommended because it is similar to Valsalva's maneuver, which can stimulate cardiac arrhythmias.

The nurse is teaching a client with chronic obstructive pulmonary disease (COPD) to assess for signs and symptoms of right- sided heart failure. Which signs and symptoms should be included in the teaching plan? clubbing of nail beds hypertension peripheral edema increased appetite

peripheral edema Right-sided heart failure is a complication of COPD that occurs because of pulmonary hypertension. Signs and symptoms of right-sided heart failure include peripheral edema, jugular venous distention, hepatomegaly, and weight gain due to increased fluid volume. Clubbing of nail beds is associated with conditions of chronic hypoxemia. Hypertension is associated with left-sided heart failure. Clients with heart failure have decreased appetites.

When instructing clients on how to decrease the risk of developing chronic obstructive pulmonary disease (COPD), the nurse should emphasize which instruction? Participate regularly in aerobic exercises. Maintain a high-protein diet. Avoid exposure to people with known respiratory infections. Abstain from cigarette smoking

Abstain from cigarette smoking. Cigarette smoking is the primary cause of COPD. Other risk factors include exposure to environmental pollutants and chronic asthma. Participating in an aerobic exercise program, although beneficial, will not decrease the risk of COPD. Insufficient protein intake and exposure to people with respiratory infections do not increase the risk of COPD.

A client with chronic obstructive pulmonary disease (COPD) is experiencing dyspnea and has a low PaO2 level. The nurse plans to administer oxygen as prescribed. Which statement is true concerning oxygen administration to a client with COPD? High oxygen concentrations will cause coughing and dyspnea. High oxygen concentrations may inhibit the hypoxic stimulus to breathe. Increased oxygen use will cause the client to become dependent on the oxygen. Administration of oxygen is contraindicated in clients who are using bronchodilators.

High oxygen concentrations may inhibit the hypoxic stimulus to breathe. Clients who have a long history of COPD may retain carbon dioxide (CO2). Gradually, the body adjusts to the higher CO2 concentration, and the high levels of CO2 no longer stimulate the respiratory center. The major respiratory stimulant then becomes hypoxemia. Administration of high concentrations of oxygen eliminates this respiratory stimulus and leads to hypoventilation. Oxygen can be drying if it is not humidified, but it does not cause coughing and dyspnea. Increased oxygen use will not create an oxygen dependency; clients should receive oxygen as needed. Oxygen is not contraindicated with the use of bronchodilators.

The nurse is planning to teach a client with chronic obstructive pulmonary disease how to cough effectively. Which instruction should be included? Take a deep abdominal breath, bend forward, and cough three or four times on exhalation. Lie flat on the back, splint the thorax, take two deep breaths, and cough. Take several rapid, shallow breaths, and then cough forcefully. Assume a side-lying position, extend the arm over the head, and alternate deep breathing with coughing.

Take a deep abdominal breath, bend forward, and cough three or four times on exhalation. The goal of effective coughing is to conserve energy, facilitate removal of secretions, and minimize airway collapse. The client should assume a sitting position with feet on the floor if possible. The client should bend forward slightly and, using pursed-lip breathing, exhale. After resuming an upright position, the client should use abdominal breathing to slowly and deeply inhale. After repeating this process three or four times, the client should take a deep abdominal breath, bend forward, and cough three or four times upon exhalation ("huff" cough). Lying flat does not enhance lung expansion; sitting upright promotes full expansion of the thorax. Shallow breathing does not facilitate removal of secretions, and forceful coughing promotes collapse of airways. A side-lying position does not allow for adequate chest expansion to promote deep breathing.

Which statement indicates that the client with chronic obstructive pulmonary disease (COPD) who has been discharged to home understands the care plan?The client: plans to avoid direct contact with family and friends. can state actions to reduce pain. will use oxygen via a nasal cannula at 5 L/min. agrees to call the health care provider (HCP) if dyspnea on exertion increases.

agrees to call the health care provider (HCP) if dyspnea on exertion increases. Increasing dyspnea on exertion indicates that the client may be experiencing complications of COPD. Therefore, the client should notify the HCP. It is not necessary to avoid being around others. Pain is not a common symptom of COPD. Clients with COPD use low-flow oxygen supplementation (1 to 2 L/min) to avoid suppressing the respiratory drive, which, for these clients, is stimulated by hypoxia.

The nurse is instructing the client with chronic obstructive pulmonary disease to do pursed-lip breathing. What is the expected outcome of this exercise? improved oxygen intake deeper diaphragmatic breathing stronger intercostal muscles better elimination of carbon dioxide

better elimination of carbon dioxide Pursed-lip breathing prolongs exhalation and prevents air trapping in the alveoli, thereby promoting carbon dioxide elimination. By prolonging exhalation and helping the client relax, pursed-lip breathing helps the client learn to control the rate and depth of respiration. Pursed-lip breathing does not promote the intake of oxygen, strengthen the diaphragm, or strengthen intercostal muscles.

The nurse is assessing the respiratory status of a client who is experiencing an exacerbation of chronic obstructive pulmonary disease (COPD) secondary to an upper respiratory tract infection. Which finding is expected? normal breath sounds prolonged inspiration normal chest movement coarse crackles and rhonchi

coarse crackles and rhonchi Exacerbations of COPD are commonly caused by respiratory infections. Coarse crackles and rhonchi would be auscultated as air moves through airways obstructed with secretions. In COPD, breath sounds are diminished because of an enlarged anteroposterior diameter of the chest. Expiration, not inspiration, becomes prolonged. Chest movement is decreased as lungs become overdistended.

A nurse is assessing a client with chronic emphysema. Which finding requires immediate intervention? using pursed-lip breathing and prolonged expiration circumoral cyanosis crackles auscultated posteriorly halfway up the left lung appearance of a "barrel chest"

crackles auscultated posteriorly halfway up the left lung Crackles auscultated in the lung field indicate excessive fluid, a problem that requires immediate intervention. Pursed-lip breathing and a prolonged expiratory phase, circumoral cyanosis, and increased anterior-posterior diameter of the chest (resulting in "barrel chest") are not unusual findings for clients with emphysema.

When developing a discharge plan with a client with chronic obstructive pulmonary disease (COPD), what information should the nurse include in the plan?People with COPD: develop respiratory infections easily. usually maintain their current status. require less supplemental oxygen. show permanent improvement.

develop respiratory infections easily. A client with COPD is at high risk for development of respiratory infections. COPD is slowly progressive; therefore, maintaining current status and establishing a goal that the client will require less supplemental oxygen are unrealistic expectations. Treatment may slow progression of the disease, but permanent improvement is highly unlikely.

Which diet would be most appropriate for a client with chronic obstructive pulmonary disease (COPD)? low-fat, low-cholesterol diet bland, soft diet low-sodium diet high-calorie, high-protein diet

high-calorie, high-protein diet The client should eat high-calorie, high-protein meals to maintain nutritional status and prevent weight loss that results from the increased work of breathing. The client should be encouraged to eat small, frequent meals. A low-fat, low-cholesterol diet is indicated for clients with coronary artery disease. The client with COPD does not necessarily need to follow a sodium-restricted diet, unless otherwise medically indicated. There is no need for the client to eat bland, soft foods.

The nurse is assessing a client with chronic obstructive pulmonary disease. Which finding requires immediate intervention? distant heart sounds diminished lung sounds inability to speak pursed-lip breathing

inability to speak Inability to speak could indicate respiratory distress. Pursed-lip breathing, while it is an abnormal finding, is not indicative of respiratory distress. Distant heart sounds could indicate heart failure but are not indicative of any distress. Diminished lung sounds may be normal for this client and do not require immediate intervention.

The nurse administers theophylline to a client. When evaluating the effectiveness of this medication, what is an expected outcome? suppression of the client's respiratory infection decrease in bronchial secretions less difficulty breathing thinning of tenacious, purulent sputum

less difficulty breathing Theophylline is a bronchodilator that is administered to relax airways and decrease dyspnea. Theophylline is not used to treat infections and does not decrease or thin secretions.

Which is a priority goal for the client with chronic obstructive pulmonary disease (COPD)? maintaining functional ability minimizing chest pain increasing carbon dioxide levels in the blood treating infectious agents

maintaining functional ability A priority goal for the client with COPD is to manage the signs and symptoms of the disease process so as to maintain the client's functional ability. Chest pain is not a typical symptom of COPD. The carbon dioxide concentration in the blood is increased to an abnormal level in clients with COPD; it would not be a goal to increase the level further. Preventing infection would be a goal of care for the client with COPD.